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Toxoplasmosis

Toxoplasmosis (tok-so-plaz-MOE-sis) is a disease that results from infection with the Toxoplasma gondii parasite, one of the world's most common parasites.

Toxoplasmosis may cause flu-like symptoms in some people, but most people affected never develop signs and symptoms. For infants born to infected mothers and for people with weakened immune systems, toxoplasmosis can cause extremely serious complications.

If you're generally healthy, you probably won't need any treatment for toxoplasmosis. If you are pregnant or have lowered immunity, certain medications can help reduce the infection's severity. The best approach, though, is prevention.

Symptoms
Causes
Risk factors
Complications
Prevention

If you're healthy, you probably won't know you've contracted toxoplasmosis. Some people, however, develop signs and symptoms similar to those of the flu, including:

Body aches

Swollen lymph nodes

Headache

Fever

Fatigue

In people with weakened immune systems

If you have HIV/AIDS, are receiving chemotherapy or have recently had an organ transplant, a previous toxoplasma infection may reactivate. In that case, you're more likely to develop signs and symptoms of severe infection, including:

Headache

Confusion

Poor coordination

Seizures

Lung problems that may resemble tuberculosis or Pneumocystis jiroveci pneumonia, a common opportunistic infection that occurs in people with AIDS

In babies

If you become infected for the first time just before or during your pregnancy, you can pass the infection to your baby (congenital toxoplasmosis), even if you don't have signs and symptoms yourself.

Your baby is most at risk of contracting toxoplasmosis if you become infected in the third trimester and least at risk if you become infected during the first trimester. On the other hand, the earlier in your pregnancy the infection occurs, the more serious the outcome for your baby.

Many early infections end in stillbirth or miscarriage. Children who survive are likely to be born with serious problems, such as:

Seizures

An enlarged liver and spleen

Yellowing of the skin and whites of the eyes (jaundice)

Severe eye infections

Only a small number of babies who have toxoplasmosis show signs of the disease at birth. Often, infected children don't develop signs and symptoms — including hearing loss, mental disability or serious eye infections — until their teens or later.

When to see a doctor

If you are living with HIV or AIDS or are pregnant or thinking of becoming pregnant, talk to your doctor about being tested.

Related

You're likely to start by seeing your family doctor, or if you're pregnant, your obstetrician. You may be referred to a doctor who specializes in infectious diseases. If you're pregnant, you may be referred to a doctor who specializes in fetal health (perinatologist) or newborn health (neonatologist).

Here's some information to help you get ready for your appointment.

What you can do

You may want to write a list that includes:

Descriptions of your symptoms

Information about medical problems you've had

Information about the medical problems of your parents or siblings

Medications and dietary supplements you take

Questions you want to ask the doctor

For toxoplasmosis, some basic questions to ask your doctor include:

What tests do I need?

What treatments are available, and which do you recommend?

What side effects might I expect from treatment?

I'm pregnant. What effect will this have on my baby?

I have other heath problems. How can I manage them together?

Are there brochures or other printed materials I can have? What websites do you recommend?

Don't hesitate to ask other questions, as well.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

When did your symptoms start?

How severe are your symptoms?

Have you recently consumed raw or undercooked meat?

Do you own or care for a cat? Who changes the litter box?

Do you wear gloves when gardening or working with soil?

Do you have conditions or take medications that affect your immune system?

Most pregnant women in the United States aren't routinely screened for toxoplasmosis, and most states don't screen infants for the infection. Without specific screening, toxoplasmosis is often difficult to diagnose because signs and symptoms, when they occur, are similar to those of more common illnesses, such as the flu and mononucleosis.

Testing during pregnancy

If your doctor suspects you have the infection, you may have blood tests that check for antibodies to the parasite. Antibodies are proteins produced by your immune system in response to the presence of foreign substances, such as parasites. Because these antibody tests can be difficult to interpret, the Centers for Disease Control and Prevention recommends that all positive results be confirmed by a laboratory that specializes in diagnosing toxoplasmosis.

What test results mean

Sometimes you may be tested early in the course of the disease before your body has a chance to produce antibodies. In that case, you may have a negative result, even though you're infected. To be certain, your doctor may recommend retesting several weeks later.

In most cases, a negative toxoplasmosis test result means you've never been infected and therefore aren't immune to the disease. If you're at high risk, you can take certain precautions so that you don't become infected.

A positive result could mean that you have an active infection, or it could mean that you were once infected and are immune to the disease. Additional tests can pinpoint when the infection occurred, based on the types of antibodies in your blood. This is especially important if you're pregnant or you have HIV/AIDS.

Testing your baby

If you're pregnant and have a current toxoplasmosis infection, the next step is to determine whether your baby also is infected. Tests your doctor may recommend include:

Amniocentesis. In this procedure, which may be done safely after 15 weeks of pregnancy, your doctor uses a fine needle to remove a small amount of fluid from the fluid-filled sac that surrounds the fetus (amniotic sac). Tests are then performed on the fluid to check for evidence of toxoplasmosis. Amniocentesis carries a slight risk of miscarriage and minor complications, such as cramping, leaking fluid or irritation where the needle was inserted.

Ultrasound scan. This test uses sound waves to produce images of your baby in the womb. A detailed ultrasound can't diagnose toxoplasmosis. It can show whether your baby has certain signs, such as fluid buildup in the brain (hydrocephalus). However, a negative ultrasound doesn't rule out the possibility of infection. For that reason, your newborn will need an examination and follow-up blood tests during the first year of life.

Testing in severe cases

If you've developed a life-threatening illness such as encephalitis, you may need one or more imaging tests to check for lesions or cysts in your brain. These include:

Magnetic resonance imaging (MRI). This test uses a magnetic field and radio (electromagnetic) waves to create cross-sectional images of your head and brain. During the procedure, you lie inside a large, doughnut-shaped machine that contains a magnet surrounded by coils that send and receive radio waves.

In response to the radio waves, your body produces faint signals that are picked up by the coils and processed into images by a computer. MRI is noninvasive and poses no risks to your health.

Brain biopsy. In rare cases, especially if you don't respond to treatment, a neurosurgeon may take a small sample of brain tissue. The sample is then analyzed in a laboratory to check for toxoplasmosis cysts.

Most healthy people don't require toxoplasmosis treatment. But if you're otherwise healthy and have signs and symptoms of acute toxoplasmosis, your doctor may prescribe the following drugs:

Pyrimethamine (Daraprim). This medication, typically used for malaria, is a folic acid antagonist. It may prevent your body from absorbing the B vitamin folate (folic acid, vitamin B-9), especially when you take high doses over a long period. For that reason, your doctor may recommend taking additional folic acid.

Other potential side effects of pyrimethamine include bone marrow suppression and liver toxicity.

Sulfadiazine. This antibiotic is used with pyrimethamine to treat toxoplasmosis.

Treating people with HIV/AIDS

If you have HIV/AIDS, the treatment of choice for toxoplasmosis is also pyrimethamine and sulfadiazine, with folic acid. An alternative is pyrimethamine taken with clindamycin (Cleocin) — an antibiotic that can cause severe diarrhea.

You may need to take these medications for life, but it's possible your dose may be lowered. If your doctor prescribes toxoplasmosis therapy to prevent toxoplasmosis, you may be able to stop taking toxoplasmosis medication if your CD4 count — the amount of a particular white blood cell in your blood — remains high for at least three to six months.

Treating pregnant women and babies

If you're pregnant and infected with toxoplasmosis but your baby isn't affected, you may be given the antibiotic spiramycin. Use of this drug may reduce your baby's risk of neurological problems from congenital toxoplasmosis. Spiramycin is routinely used to treat toxoplasmosis in Europe. But it is still considered experimental in the United States. Your doctor can obtain it from the Food and Drug Administration.

If tests show that your unborn child has toxoplasmosis, your doctor may suggest treatment with pyrimethamine and sulfadiazine — but only in extreme circumstances and after the 16th week of pregnancy. These drugs can have serious side effects for women and their unborn babies, so they're normally not used during pregnancy.

If your infant has toxoplasmosis or is likely to have it, treatment with pyrimethamine and sulfadiazine and folic acid is recommended. Your baby's doctor will need to monitor your baby while he or she is taking these medications.